World Neurosurg
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Intraoperative multimodal neuromonitoring (IONM) is considered valuable for the early detection and prevention of any neurologic compromise during spine surgery. It has also become the standard of care at many institutions to improve the surgical outcome and be a safety net for both clinical and medicolegal concerns. ⋯ Despite our analysis proving no difference in clinical outcomes with or without the use of IONM during surgical excision of lumbar schwannomas, we still prefer using IONM as a standard approach. It adds to the confidence and ease of mind of the surgeon during resection and also provides valuable data in cases of medicolegal disputes. However, it comes with an increased cost and lengthened surgical procedure.
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Intracranial dural arteriovenous fistula (DAVF) consists of a meshwork of arteriovenous shunts. Drainage of the fistula may be into a dural sinus or directly into cortical veins. Rarely, dural arteriovenous fistulas drain exclusively into perimedullary veins. Prompt diagnosis is important, as the clinical course is potentially life threatening. ⋯ Early diagnosis of this rare vascular malformation is challenging; angiographic studies must include the cranial vasculature when spinal studies are normal or if the abnormality on magnetic resonance imaging is maximal in the upper spinal cord. In the case described, as only medullary angiography was performed, the intracranial dural arteriovenous fistula with perimedullary venous drainage was not diagnosed. Delayed diagnosis is likely to lead to severe neurologic consequences.
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Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible edematous lesions on imaging examinations, along with symptoms of altered consciousness disorder and seizures. Various factors associated with PRES have been reported. However, we encountered a very rare case that developed after clipping surgery for unruptured cerebral aneurysm. ⋯ Based on the literature, this case was considered to represent PRES caused by rapid blood pressure fluctuations accompanying general anesthesia for clipping surgery. Practitioners must keep PRES in mind as a rare complication after clipping for unruptured cerebral aneurysms. PRES developing after craniotomy shows unilaterality and may become severe in the craniotomy area and leave sequelae.
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Arachnoid cysts are common anomalies in the intracranial region. However, an intraventricular arachnoid cyst is rare, and occurrence within the fourth ventricle is especially uncommon; only 16 cases have been described in the literature. Arachnoid cysts in the fourth ventricle may cause obstructive hydrocephalus or cerebellar ataxia or cranial nerve palsy. Treatment of a fourth ventricular arachnoid cyst is complete or partial resection via a midline suboccipital approach. Recently, endoscopic fenestration has become the procedure of choice in the treatment of arachnoid cysts in supratentorial locations, but as yet there has been no report of treating a fourth ventricle arachnoid cyst using a flexible endoscope. ⋯ As per our knowledge, this is the first case reporting the treatment of an arachnoid cyst of the fourth ventricle using a flexible endoscope via the anterior horn of the lateral ventricle. This method can be used to treat arachnoid cysts of the fourth ventricle.
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We sought to identify the morphological features of the relationship between the manubrium and vertebrae of the cervicothoracic junction for use in guidelines for the selection of the appropriate surgical approach. ⋯ Our results have provided insight into the anatomy of the manubrium and vertebrae of the cervicothoracic junction. Furthermore, our results have shown that, for most people, the T1 forms the boundary of the manubriotomy. We found that both the distance and angle differed significantly according to sex. A better understanding of the radiological anatomy of the surgeons' view line will help in the preoperative assessment of patients and in indicating an appropriate surgical approach.